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People with learning disabilities still face inequalities in access to health services. This article, which comes with a handout for a journal club discussion, sums up what nurses can do to reduce these inequalities

Charities have called for urgent action to address staffing and funding shortfalls in neonatal care in the light of a report highlighting ongoing variations in stillbirths and newborn baby death rates.

The report, published by a team of academics, clinicians and charity representatives, shows a slight fall in overall stillbirth and neonatal death rates across the UK in 2014.

“Units are already struggling to deliver current initiatives to reduce baby deaths”

Judith Abela

The rate of stillbirths per 1,000 dropped from 4.2 in 2013 to 4.16 in 2014, while neonatal deaths fell from 1.84 per 1,000 to 1.77. However, the data reveals significant variation in death rates that cannot purely be explained by factors such as poverty, more older mothers giving birth and more multiple births.

Among organisations responsible for commissioning care, perinatal death rates ranged from 4.9 to 7.1 deaths per 1,000 births.

“Funding for work into the reduction of preterm birth is vital in the battle to reduce these numbers”

David Field

There was significant variation within groups of trusts and boards delivering similar types of services. This was particularly true for those delivering the most complex care via Level 3 intensive care units providing neonatal surgery, where mortality rates varied from 6 to 9.7 deaths per 1,000.

MBRRACE-UK uses a traffic light system to identify organisations with high mortality rates that are a matter of concern and where action is needed.

It flagged up the fact about two thirds of neonatal deaths and stillbirths were preterm and said there was a need to focus efforts on reducing preterm births.

“The very significant impact of this group on overall rates of stillbirths and neonatal deaths is stark,” said report author David Field, professor of neonatal medicine at the University of Leicester.

More nursing staff key to reducing baby deaths, say charities

David Field

“Funding for work into the reduction of preterm birth is vital in the battle to reduce these numbers,” he said.

Campaign groups and nursing organisations said more resources were desperately needed overall to improve services and achieve a government goal of halving the rate of stillbirths, neonatal deaths, brain injuries and maternal deaths by 2030.

The government has committed £2.4m to this ambition but charities and others claim that is not nearly enough.

“Units are already struggling to deliver current initiatives to reduce baby deaths,” said Judith Abela, acting chief executive at the charity Sands.

“Women at risk require more scans in pregnancy and there are not enough sonographers; midwives need protected time for training in order to be safe to practise, but this isn’t guaranteed; and some units do not have the funds to buy equipment or resource services adequately to monitor women,” she said.

“A significant fall in the rates of stillbirth and neonatal death will not succeed without a clearer strategy, supported by adequate funding,” she added.

Its recent Baby Report for England estimated 2,140 extra nurses were needed to care for babies.

It found two thirds of units did not have enough specialist nurses and more than 850 babies were transferred between hospitals in 2015 because there was not enough space or staff at the unit they were in.

Meanwhile 70% of neonatal intensive care units were consistently caring for more babies than considered safe.

“Over 90,000 babies born in the UK each year depend on neonatal care to survive and thrive – and that care depends on having the right number of nurses and doctors in place to meet quality standards,” said Bliss chief executive Caroline Davey.

The Royal College of Nursing also called for funding for specialist units, as well as more resources for public health work and efforts to address health inequalities.

Meanwhile the Royal College of Midwives said it was vital midwives were actively involved in any local or national work to reduce stillbirths.

‘Unprecedented’ nurse shortages hitting neonatal units

Caroline Davey

“They know their local population, they know how the service works and they know how it can work better,” said RCM director of midwifery Louise Silverton.

Other issues identified by the MBRRACE-UK analysis included the low rate of post mortems, which can provide vital information on why a baby has died.

In 2014 the cause of death for about half of stillbirths and a tenth of neonatal deaths was unknown. More than 90% of parents whose baby died were offered a post mortem but just over 40% agreed.

The report also found huge variation in the proportion of deaths put down to major congenital abnormalities, such as serious heart defects.

The proportion of perinatal deaths with congenital abnormality recorded as the primary cause varied from none to more than half between trusts and health boards in different areas.

The MBRRACE-UK team said this variation could be down to differences in the way cause of death was interpreted and needed further investigation.

Health minister Ben Gummer said: “It is positive that progress has been made, but this important report is further evidence that we must continue to tackle variation to help ensure far fewer families go through the heartache of losing a child.

“We’ve committed to halve the number of stillbirths and neonatal deaths by 2030 – we are also investing in improved training for staff, new safety equipment and making sure hospitals review and learn from every tragic case,” he said.

The government recently announced an ambition to halve the number of stillbirths, neonatal deaths, maternal deaths and neonatal brain injuries occurring during or soon after birth by 2030, which is backed with £500,000 for a new improved review process, £1m in improved training for staff, £2m in a new safety equipment fund shared among 90 trust and £365m on perinatal mental health.

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All nursing and midwifery staff who come face to face with parents suffering the loss of a baby shortly after birth should receive training on how best to support them, charities have urged.

Readers' comments (1)

Anonymous2 August, 2016 5:50 pm

Why don't more higher education institutions offer the 18 month Post RN Midwifery course? There are lots of Adult registered nurses who would love to go on to study midwifery but not enough places on courses and the number of universities offering the course (especially in the north) is dwindling.

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